Section 7
Mental and physical health
34
Neuroendocrinological aspects of social anxiety and aggression-related disorders
Dorien Enter, Moniek H. M. Hutschemaekers, and Karin Roelofs
Steroid hormones, like cortisol and testosterone, play an important role in the regulation of social motivational behavior. Whereas testosterone facilitates threat approach, presumably by facilitating dopaminergic projections from the amygdala to the striatum (de Souza Silva, Mattern, Topic, Buddenberg, & Huston, 2009; Hermans et al., 2010; Radke et al., 2015), cortisol increases threat avoidance, particularly in highly socially anxious individuals (van Peer et al., 2007; van Peer, Spinhoven, Dijk, & Roelofs, 2009). Interestingly, social motivational disorders, such as social anxiety and aggression-related disorders, show an imbalance in these steroid hormones: social anxiety has been associated with increased cortisol stress-responses and decreased testosterone levels (Gerra et al., 2000; Giltay et al., 2012; Roelofs, Minelli, Mars, van Peer, & Toni, 2009), while aggressive psychopathologies have been linked to increased testosterone levels (Glenn, Raine, Schug, Gao, & Granger, 2011; Montoya, Terburg, Bos, & van Honk, 2012; Volman et al., 2016). In this chapter, we discuss the role of these steroid hormones and the neuropeptide oxytocin in social psychopathologies, especially social anxiety and psychopathy. First, we will give a description of the neuroendocrine aspects of social motivational behavior, including social approach and avoidance behaviors. Then we will focus on the neuroendocrine aspects of social anxiety and aggression-related disorders. Finally, motivational and psychiatric findings will be integrated, followed by a research agenda, aiming to provide starting points for clinical applications.
Social motivational action
The term motivation reflects a broad concept related to anything that may prompt the person to act in a certain way, or to develop an inclination for specific behavior. In this chapter though, we will focus largely on social motivational actions that can be roughly divided into social approach and social avoidance (Davidson, Ekman, Saron, Senulis, & Friesen, 1990; Gray, 1994). These action tendencies involve a basic response to stimulus valence. They are mediated by primary motivational systems of the brain -whereby reward potentiates behavioral activation, while punishment promotes behavioral inhibition or avoidance - and are thought to underlie every complex emotional responding (Carver & White, 1994; Gray & MacNaughton, 2000). Successful social functioning depends on adaptive regulation of these social approach and avoidance responses.
Both automatic defensive action tendencies and more instrumental (or goal-directed) mechanisms shape an individualâs behavior. When an individual encounters a social stimulus (e.g., an angry facial expression directed at him/her), he/she will engage in an automatic defensive freeze and flight-or-fight response, a quick and automatic sequence of defensive responses stages (Bradley, Codispoti, Cuthbert, & Lang, 2001). During threat exposure in particular, an initial freezing response is activated during which the individual ceases all ongoing activity and perception is enhanced to quickly assess the situation in order to optimize subsequent fight-or-flight responses (Blanchard, Griebel, Pobbe, & Blanchard, 2011; Lojowska, Gladwin, Hermans, & Roelofs, 2015; Roelofs, Hagenaars, & Stins, 2010). This is an automatic process, and the evaluation directly results in a behavioral disposition towards the stimulus: aversive stimuli generally elicit the tendency to move away from the stimulus and appetitive stimuli will elicit a tendency to move towards the stimulus (Lang, Bradley, & Cuthbert, 1997). Such automatic tendencies can also influence more complex, instrumental approachâavoidance decision making (Geurts, Huys, den Ouden, & Cools, 2013; Guitart-Masip, Duzel, Dolan, & Dayan, 2014). For instance, Ly and colleagues (2014) tested such influence in 45 healthy human individuals using an experimental set-up in which automatic freezing reactions towards negatively (versus positively) valenced stimuli were disentangled from instrumental approachâavoidance decisions (guided by monetary rewards and punishments). Critically, the transfer of valence (and related automatic reactions) to the instrumental approachâavoidance actions were systematically tested. The valence of angry (versus happy) faces was indeed found to transfer to instrumental decision making, in such a way that it induced an instrumental avoidance bias. The extent of freezing elicited by the angry faces was significantly correlated to the instrumental avoidance bias.
Both automatic freezeâfightâflight tendencies and more instrumental approach and avoidance biases have been suggested to play a prominent role in the maintenance and perhaps even cause of psychopathology (Blanchard et al., 2011; Rudaz, Ledermann, Margraf, Becker, & Craske, 2017; Turk, Lerner, Heimberg, & Rapee, 2001; Wong & Moulds, 2011). Aggression, for instance, has been conceptualized as a defensive response system in which automatic fight-responses are triggered too easily and in which instrumental threatâapproach tendencies become well-learned and rewarded (Blair, 2013; Blanchard et al., 2011; Ly et al., 2016). On the contrary, persistent avoidance in anxiety disorders has been thought of as a defensive response system in which automatic flightâresponses are easily triggered and in which instrumental threatâavoidance tendencies become rewarded and well-learned (Blanchard et al., 2011).
Rolls (2000) emphasized the importance of facial expressions as input for these systems, as they convey social information. When applied in social approachâavoidance tasks (AATs), healthy people show a general tendency to move away from angry expressions and to approach happy faces (Bradley et al., 2001; Chen & Bargh, 1999; Heuer, Rinck, & Becker, 2007; Roelofs, Minelli et al., 2009; Volman, Toni, Verhagen, & Roelofs, 2011). Social AATs using emotional faces have therefore been used to objectively measure the motor responses that are brought about by the automatic and instrumentally driven tendency to approach or avoid a certain stimulus (Chen & Bargh, 1999; Heuer et al., 2007; Roelofs, Elzinga, & Rotteveel, 2005; Rotteveel & Phaf, 2004). A commonly used type is a manual reaction time task which requires participants to approach and to avoid socially appetitive and aversive visually presented stimuli (happy and angry faces, respectively) by pulling (approach) or pushing away (avoidance) a joystick (see Figure 34.2E). In zooming versions of the AAT, pulling or pushing the joystick increases or decreases the size of the picture respectively, giving the impression of moving towards or moving away from the participant (Heuer et al., 2007). Affectâbehavior congruence (i.e., approaching happy or avoiding angry faces) leads to quicker responses than when automatic tendencies need to be overridden, as is the case with affectâbehavior incongruence (i.e., approaching angry or avoiding happy faces). Highly socially anxious individuals have been shown to avoid socially threatening (i.e., angry) faces, compared to low anxious controls (Heuer et al., 2007; Roelofs, Putman et al., 2010), while psychopathic offenders show diminished avoidance tendencies of angry faces, compared to controls (von Borries et al., 2012).
Neurobiology underlying social motivational behavior...